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Durante estos últimos años hemos asistido a un incremento significativo de la resistencia de los microorganismos grampositivos, con un impacto epidemiológico y clínico importante en la práctica diaria. Mientras que en los hospitales españoles la prevalencia de Staphylococcus aureus resistente a la meticilina (SARM) se mantiene en unos valores elevados (alrededor del 25%), en la comunidad están emergiendo nuevas cepas de SARM en pacientes sin factores de riesgo, a menudo productoras de toxinas como la leucocidina de Panton- Valentine. Por otra parte, los estafilococos coagulasanegativos (ECN) están implicados en una gran variedad de infecciones hospitalarias y su resistencia a los antimicrobianos es globalmente superior (p. ej., > 60% a la meticilina) y de más rápida adquisición, en general, que la de S. aureus. Destaca un tercer grupo de microorganismos, Enterococcus sp., por el incremento significativo de la resistencia a ampicilina en E. faecium (el 75% en 2006), y por la emergencia de resistencia a la vancomicina, principalmente en E. faecium (el 3,9% en 2006). Los estudios revisados en este artículo muestran los cambios epidemiológicos experimentados recientemente y la emergencia y diseminación de cepas multirresistentes. Esta diseminación se está produciendo dentro de los hospitales, entre hospitales y centros sociosanitarios, dentro la propia comunidad, e incluso entre países y continentes. Por otra parte, la existencia de un reservorio nosocomial de genes de resistencia, en algunos casos potencialmente transmisibles mediante transferencia horizontal, puede contribuir a agravar el problema de la resistencia y a restringir las opciones terapéuticas.
Palabras clave:
Staphylococcus aureus
Estafilococo coagulasa-negativo
Enterococo resistente a vancomicina
Epidemiología
Resistencia
In the last few years, there has been a significant increase in resistance among Gram-positive microorganisms, with a marked epidemiological and clinical impact in daily clinical practice. While the prevalence of methicillinresistant Staphylococcus aureus (MRSA) in Spanish hospitals remains high (approximately 25%), in the community new MRSA strains are emerging in patients without risk factors, often producing toxins such as Panton-Valentine leucocidin. In addition, coagulasenegative staphylococci (CNS) are involved in a wide variety of hospital infections and their resistance to antimicrobial agents is higher (e.g. > 60% to methicillin) and more rapidly acquired, in general, than that of S. aureus. The third group of microorganisms, Enterococcus sp. are notable for the significant increase in ampicillin resistance in E. faecium (75% in 2006), and for the emergence of vancomycin resistance, mainly in E. faecium (3.9% in 2006). The studies reviewed in the present article show the recent epidemiological changes that have taken place and the emergence and dissemination of multiresistant strains. This dissemination is being produced within hospitals, among hospitals and nursing homes, within the community, and even among countries and continents. Moreover, the existence of a nosocomial reservoir of resistance genes, in some cases potentially transmissible through horizontal transfer, could contribute to exacerbating the problem of resistance and to restricting therapeutic options.
Key words:
Staphylococcus aureus
Coagulase-negative staphylococci
Vancomycin-resistant Enterococcus
Epidemiology
Resistance
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